Submucosal jejunal hematoma with hemoperitoneum

Case contributed by Dr Ammar Haouimi

Presentation

Patient under anticoagulant therapy for heart failure. Treated for COVID-19 pneumonia 8 months ago. Presented with severe left abdominal pain.

Patient Data

Age: 65 years
Gender: Male

The CT scan demonstrates a regular circumferential submucosal thickening of the proximal jejunum (length = 16 cm) with preserved mucosal layer. There is mesenteric vascular congestion with free intraperitoneal effusion mainly around the spleen, in the left paracolic gutter, and pelvis (mean density of fluid = 35 HU). The mesenteric vessels (SMV and SMA) are patent.

Case Discussion

The CT features with the absence of mesenteric vascular occlusion in a patient under anticoagulant therapy suggest a submucosal jejunal hematoma with hemoperitoneum.

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